Continuous transesophageal echo-Doppler assessment of hemodynamic function during laparoscopic cholecystectomy

Study Objective: The objective of this study was to examine the utility of the transesophageal echo-Doppler device in evaluating hemodynamic changes during laparoscopic cholecystectomy. Design: This was a prospective, controlled, observational open study. Setting: The study took place in a university hospital. Patients: Twenty patients with ASA physical statuses II and III undergoing laparoscopic cholecystectomy were enrolled into the study. Interventions and Measurements: A standardized general anesthetic and surgical technique was used for all patients. Similar depth of hypnosis (using bispectral index monitoring) was maintained in all patients. Hemodynamic parameters including mean arterial pressure (MAP), cardiac index (CI), left ventricular (LV) ejection time interval indexed to the heart rate, maximum acceleration, peak velocity, and systemic vascular resistance (SVR) were recorded at predetermined intervals: before incision, after peritoneal CO₂ insufflation and head-up tilt, every 10 minutes thereafter, and after deflation of the abdomen and return to supine position. Main Results: The transesophageal echo-Doppler probe placement was achieved in 3 to 5 minutes in all patients, and the probe position was maintained after creation of pneumoperitoneum and change in positioning. Induction of pneumoperitoneum and head-up tilt resulted in a significant increase in MAP and SVR (P < .05) that remained higher until deflation. The CI, LV ejection time interval indexed to the heart rate (a measure of LV filling), and maximum acceleration (a measure of contractility and global ventricular function) remained stable. Conclusions: The transesophageal echo-Doppler device can be used during laparoscopic cholecystectomy. The LV function, as determined by measurement of CI and maximum acceleration, was preserved during laparoscopic cholecystectomy despite significant increases in afterload (ie, MAP and SVR).